Koong H N, Chan H S, Nambiar R, Soo K C, Ho J, Ng H S, Ng E H
Department of General Surgery, Singapore General Hospital, Singapore.
Aust N Z J Surg. 1996 Dec;66(12):813-5. doi: 10.1111/j.1445-2197.1996.tb00755.x.
Mortality rates from gastric cancer, apart from those derived from Japanese series, remain poor. This paper sought to determine the present outcome of gastric carcinoma in a predominantly Chinese population in Singapore. Prognostic factors useful in predicting survival were also evaluated in this population.
All cases of histologically confirmed gastric adenocarcinoma presenting in 1992 were entered into a prospective database. Prognostic factors related to age, sex, site of disease, depth of invasion, histological grade, nodal status and stage of disease were evaluated in patients with resectable disease to determine their utility in predicting survival.
Of 131 consecutive patients with histologically proven adenocarcinomas, 37% had distant metastases at presentation predominantly in the liver (21%) and peritoneal cavity (20%). Sixty-four per cent of patients underwent surgery and in only 51% of these patients was resection of the tumour possible. Stages III and IV (T4N2) locally advanced disease were present in 38% of patients. Thus the majority of patients presented with late or metastatic disease (75%, stages III and IV). Sixty per cent of patients were alive at 1 year and 40% at 2 years after resection of the tumour (Kaplan-Meier survival plots). In contrast, no patient survived longer than a year if the tumour was not resectable (P < 0.001, log-rank test). Median survival of patients without surgery was 12 weeks. Median survival for patients with resected stage IV disease was 23 weeks, compared to 18 weeks after surgical bypass. Age, sex, site, depth of invasion and histological grade did not significantly predict survival. Patients with node-negative disease survived longer (2 years. 70%) than those with nodal involvement (2 years, 44%: P = 0.06, log-rank test). Pathologic staging with the TNM system was useful in predicting survival (P < 0.001). Sixty per cent of patients with stage I and II disease were alive at 2 years compared to 54% with stage III disease and 0% with stage IV disease.
The prognosis of stomach cancer remains poor, due predominantly to late presentation. Pathologic TNM staging and nodal status were useful in predicting survival outcome after resection. If the tumour were resectable, survival was appreciable even in patients with advanced stage III (2 years. 54%) and stage IV (1 year, 40%) disease. Strategies to improve outcome should focus on early detection of gastric carcinomas.
除日本系列研究所得数据外，胃癌死亡率一直居高不下。本文旨在确定新加坡以华裔为主的人群中胃癌的当前治疗结果。同时，还对该人群中有助于预测生存的预后因素进行了评估。
将1992年所有经组织学确诊的胃腺癌病例纳入前瞻性数据库。对可切除疾病患者的年龄、性别、疾病部位、浸润深度、组织学分级、淋巴结状态和疾病分期等预后因素进行评估，以确定其在预测生存方面的作用。
在131例经组织学证实为腺癌的连续患者中，37%在就诊时已有远处转移，主要为肝转移（21%）和腹腔转移（20%）。64%的患者接受了手术，其中仅51%的患者可行肿瘤切除。38%的患者存在Ⅲ期和Ⅳ期（T4N2）局部晚期疾病。因此，大多数患者就诊时已处于晚期或转移性疾病阶段（75%，Ⅲ期和Ⅳ期）。肿瘤切除术后1年生存率为60%，2年生存率为40%（Kaplan-Meier生存曲线）。相比之下，不可切除肿瘤的患者无一人存活超过1年（P<0.001，对数秩检验）。未接受手术患者的中位生存期为12周。Ⅳ期疾病切除术后患者的中位生存期为23周，而手术旁路术后为18周。年龄、性别、部位、浸润深度和组织学分级对生存无显著预测作用。无淋巴结转移患者的生存期更长（2年生存率70%），而有淋巴结受累患者的2年生存率为44%（P=0.06，对数秩检验）。采用TNM系统进行病理分期有助于预测生存（P<0.001）。Ⅰ期和Ⅱ期疾病患者的2年生存率为60%，Ⅲ期疾病患者为54%，Ⅳ期疾病患者为0%。
胃癌预后仍然较差，主要原因是就诊时已处于晚期。病理TNM分期和淋巴结状态有助于预测切除术后的生存结果。如果肿瘤可切除，即使是Ⅲ期晚期（2年生存率54%）和Ⅳ期（1年生存率40%）疾病患者，生存率也较为可观。改善治疗结果的策略应侧重于早期发现胃癌。
